Workers’ compensation covers the injuries and occupational diseases that are suffered by employees and that arise in the course and scope of employment. Which injuries are related to work, however, is not always easy to determine. Moreover, different state laws disagree as to where the workplace ends.
If your injury is work-related, you are entitled to at least a portion of your lost wages and your medical expenses.
Who is entitled to workers’ compensation?
Employees who have suffered a work-related injury are entitled to workers’ compensation benefits. This includes:
- full-time employees,
- part-time employees, and
- seasonal employees.
Note that this does not include independent contractors. However, these workers must be bona fide independent contractors. If your employer has misclassified you as an independent contractor and you get hurt on the job, you may be able to recover workers’ comp. However, you would first have to show that you have been misclassified.
Employers who have employees are often legally required to carry workers’ compensation insurance. If your employer does not carry workers’ comp, you may be able to recover compensation for your injury by:
- filing a personal injury lawsuit against your employer, or
- if your employer was providing a service for another company, filing a workers’ comp claim against that company as a statutory employer.1
When is a physical injury work-related?
A physical injury is work-related if it:
- arose during the course of employment, and/or
- arose out of employment.
As the injured worker, it is up to you to prove that your condition was work-related.
For physical injuries that happened in a single event, this is often easy. If you were at the worksite or performing job functions when you got hurt in an accident, it is generally work-related.
However, there are many situations that fall into a gray area between the workplace and your personal life. Some of the most common of these ambiguous situations include:
- commuting to or from work,
- social events run by your employer,
- activities done at work for your personal comfort,
- misconduct in the workplace,
- accidents that aggravate injuries that did not happen at the workplace, and
- digressions from work activities, known as frolics or detours.
Courts in different states have drawn the line differently for many of these situations. In some others, there is a bright line rule that requires workers’ comp benefits or excludes coverage. In many cases, these rules have exceptions.
Commuting to or from work
Generally, workers’ compensation does not cover injuries sustained in accidents during the commute. This is often known as the “coming-and-going” doctrine. You are not covered by workers’ comp up to the moment that you check in, and from the moment you leave.
For example: Mary is driving in to work when she is hit in a car accident. Even though the accident occurred within sight of her office building, she is not covered by workers’ comp.
However, if your commute involves performing job responsibilities, injuries suffered during it may be covered.
For example: Loretta works primarily from home. One day she has to pick up mail from her employer’s office. On the way, she is hurt in a car accident. Because her trip was work-related, her injuries are covered by workers’ comp.2
The job duties exception can apply in a wide variety of commuting circumstances. Some of the most common include:
- traveling salespeople,
- commuting from one worksite to another,
- following explicit job orders, and
- driving in a company car.
Employer’s social events
On the other hand, injuries that happen during your employer’s social events are generally covered by workers’ comp. However, some state laws exclude social events from workers’ compensation coverage if:
- you voluntarily participated in them, and/or
- there is no benefit to the employer other than employee morale.3
Some common social events related to your employer can include:
- workplace kickball or softball teams,
- happy hours,
- company picnics, or
- “team building” exercises.
For example: Rich volunteers to play for his company’s softball team. During a game he gets hurt. His injuries may not covered by workers’ compensation laws that require mandatory participation.4
Activities for personal comfort
While you are at work, you engage in numerous minor activities that are for your personal comfort. A few of these include:
- walking around the office,
- using the restroom,
- making coffee,
- enjoyed a meal or rest break, and
- getting a drink from the water cooler.
These activities are small, but personal. They are not necessarily related to your work. Nevertheless, if you get hurt while engaging in one of them you are generally entitled to workers’ comp.
For example: Tricia leaves her office cubicle to make coffee in the break room. On the way, she trips, falls, and gets hurt.
Employee misconduct
Even if the injury occurs at the workplace and while you are performing work, it may still fall outside workers’ comp coverage if your misconduct caused your injuries. This happens the most often when your injuries were caused by:
- horseplay with coworkers,
- violating company policies, or
- working while under the influence of drugs or alcohol.
Self-inflicted injuries are also excluded from workers’ comp.
Preexisting injuries
Generally, injuries have to happen at the workplace or out of the course of employment to be covered by workers’ compensation. However, workplace accidents that aggravate a preexisting injury – even if that injury is not work-related – are generally covered by workers’ comp.
For example: George falls and hurts his back at work. The injury aggravates an old back injury that he got in a car accident years ago. He is entitled to compensation for his injuries, including those that he would not have suffered were it not for his preexisting back condition.
However, many workers’ comp insurance companies try to deny these cases. They claim that the preexisting condition is not work-related.
Additionally, some states have adopted laws that make it more difficult to recover workers’ compensation for preexisting injuries.5
Frolics and detours
In some cases, you can get hurt while at work but doing personal things. One way that courts determine whether workers’ comp covers the injury is how far you strayed from your job duties. These are known as:
- frolics, or
- detours.
A detour is a minor departure from your scope of employment. Workers’ compensation generally covers injuries that happen while on a detour.
A frolic is a substantial departure from your job. Workers’ comp generally does not cover injuries that happen on a frolic.
The difference between what amounts to a detour and a frolic can be fact-intensive.
When is an occupational disease covered by workers’ comp?
A disease or other health problem is work-related if it comes from your occupation rather than your normal daily life. Because these conditions happen over a longer course of time, proving that they are work-related can be difficult. It generally involves proving that you were exposed to dangerous conditions at work that are likely to cause the kinds of injuries that you suffered.
If your employer exposed you to dangerous conditions in violation of safety rules by the Occupational Safety and Health Administration (OSHA), it can be a strong sign of causation for your occupational illness.
If you cannot prove a causal connection between your health problems and your job, your workers’ comp claim will get denied.
What are some common types of injuries that are work-related?
Some common physical occupational injuries are:
- back injuries,
- hernias,
- broken bones,
- neck strains,
- shoulder issues,
- torn muscles, and
- cuts and lacerations.
These are all job-related injuries that happen at a specific moment in time.
Some common occupational diseases include:
- eye strain,
- carpal tunnel syndrome,
- cancer,
- tendonitis,
- lung diseases like black lung,
- repetitive stress injuries caused by repetitive motion activities or overuse,
- mesothelioma, and
- arthritis.
While it can be difficult to pinpoint a time when these workplace injuries occurred, they can still be the grounds for a workers’ compensation claim.
What benefits can I receive?
Each state has its own workers’ compensation law. However, they generally provide injured employees with 2 types of workers’ compensation benefits:
- medical care, and
- disability benefits.
These disability benefits are generally a portion of the wages that you have lost because of your workplace injury or disease. In many states, they are 66 percent, or two-thirds, of your pre-injury weekly wage.6
If the job injuries proved to be fatal, the victim’s dependents can receive death benefits.
A workers’ compensation attorney can help you recover the benefits that you deserve.
Legal References:
- See, e.g., Missouri Statute 287.040(1).
- Facts from Bentz v. Liberty Northwest, 57 P.3d 832 (Mont. 2002).
- See, e.g., New Jersey Statute Annotated 34:15-7.
- Facts from Dowson v. Borough of Lodi, 490 A.2d 374 (N.J. Super. Ct. App. Div. 1985).
- See Missouri Senate Bill 1 (2013) and Cosby v. Treasurer of the Second Injury Fund, 579 S.W. 3d 202 (Mo. 2019).
- See, e.g., California Labor Code 4653 LAB and Missouri Statute 287.170.
